CC Posted Thu 23rd of May, 2019 12:14:01 PM
What is the correct CPT code for Laparoscopic Salpingectomy for sterilization and Laparoscopic Salpingectomy for salpingitis? Would I use 58661 for both or 58661 for salpingitis and 58670 for sterilization?
SuperCoder Answered Fri 24th of May, 2019 04:09:38 AM
We will not bill both the codes together; rather note the below scenarios:
It is not just the case of sterilization, but the patient has salpingitis as well.
The American Congress of Obstetricians and Gynecologists (ACOG) states, removing the tubes, rather than simply fulgurating/transecting the tubes, reduces the risk of ovarian cancer. If this was done for sterilization rather than removal of disease, you may find that the payer will down-code to the lesser procedure.
Also, the work involved when the tubes are removed for sterilization is not the same as that when doing it for disease and therefore many payers are considering the work involved.
So, since the procedure is being performed for sterilization (Z30.2, Encounter for sterilization) we will go for CPT 58670. You may also use modifier 22 (Increased Procedural Services) if procedure takes more time due to salpingitis.
However, if diagnosis is given as salpingitis (N70.91, salpingitis unspecified), and there is removal of tubes, we may use CPT 58661. For bilateral procedure we will use modifier 50 and for unilateral we will use modifier 52.
So you may check with your documentation and bill accordingly just single code with appropriate modifier. In case there is still any confusion feel free to ask for any further query.
CC Posted Mon 01st of July, 2019 14:51:08 PM
What if the bilateral salpingectomy was done at the time of a cesarean section for sterilization? Would I use 58611 or 58700?
SuperCoder Answered Tue 02nd of July, 2019 06:04:59 AM
If sterilization is performed at the time of a cesarean section through salpingectomy, the appropriate code to use for this procedure will be 58700. Reason being, as per The American Congress of Obstetricians and Gynecologists (ACOG) has published information that leads many ob-gyns to think that it is better for the patient to do a salpingectomy rather than a tubal for sterilization. The reason is to prevent certain types of cancer that originate in the fallopian tube.
However, many payers do not want to pay more for a sterilization procedure, and especially not during cesarean. Historically code 58611 has paid very little as opposed to salpingectomy, but physicians would like to go for salpingectomy for sterilization.
Also, you may check with your payer to avoid denials for CPT® and ICD code mismatch.